硬膜外镇痛对开腹胰腺肿瘤手术患者术后恢复的影响  

Impact of patient controlled epidural analgesia on postoperative recovery in patients undergoing laparotomy pancreatic surgeries

作　　者：刘思颖[1] 孙兆楚 吕楠[2] 刘世江[1] 刘存明[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029 [2]南京医科大学第一附属医院胰腺外科,210029

出　　处：《临床麻醉学杂志》2017年第6期554-556,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较开腹胰腺肿瘤手术的加速康复外科(enhanced recovery after surgery,ERAS)流程中硬膜外镇痛和静脉镇痛对患者术后恢复的影响。方法选择择期行开放胰腺肿瘤手术的患者40例,男27例,女13例,年龄18~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组20例。硬膜外镇痛组(E组)行T_(8~9)或T_(9~10)硬膜外间隙穿刺置管,试验剂量给予2%利多卡因3ml,在切皮前和关腹时分别给予0.375%罗哌卡因5 ml,E组和静脉镇痛组(V组)均行丙泊酚-七氟醚静-吸复合全麻。气管拔管后,E组行硬膜外自控镇痛,V组行静脉自控镇痛。记录患者术后首次下床活动时间、住院时间、肛门排气时间等,以及恶心呕吐、皮肤瘙痒、低血压等术后并发症的发生情况。结果 E组下床活动时间明显早于V组[(50.4±4.2)h vs(64.2±5.0)h,P<0.01],术后住院时间明显短于V组[(18.5±8.5)d vs(21.5±6.8)d,P<0.05]。两组术后肛门排气时间[(39.7±4.1)h vs(39.5±8.4)h]差异无统计学意义。两组术后并发症发生率差异无统计学意义。结论在开腹胰腺肿瘤手术的加速康复外科流程中,硬膜外镇痛可产生更好的术后镇痛效果,患者可更早地下床活动,缩短住院时间,且不增加相关并发症。Objective To compare the impact of patient controlled epidural analgesia with pa- tient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries. Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status I or II , were randomly divided into two groups （n=20 each）. Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0. 375% ropivacaine 5 ml into epidural space before skin incising and incision closures. Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia. After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia. Length of hospital stay, time to ambulation and exhaust defecation were recorded. Other complications were compared. Results Compared to group V, patients in group E showed earlier ambulation [-（50.4±4. 2） h vs （64.2±5.0） h, P〈0. 01], shorter hospital stays [（18.5±8.5） d vs （21.5±6.8） d, P〈0.05]. There was no statistically significant difference in flatus time between the two groups [（39.7±4.1） h vs （39.5±8.4） hi. There was no significant difference in complications between the two groups. Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.

关 键 词：硬膜外镇痛 加速康复外科 胰腺手术 

分 类 号：R614[医药卫生—麻醉学] R735.9[医药卫生—外科学]